Department of Psychiatry, Columbia University and New York State Psychiatric Institute, USA.
Department of Psychiatry, Columbia University and New York State Psychiatric Institute, USA.
Contemp Clin Trials. 2021 Jan;100:106224. doi: 10.1016/j.cct.2020.106224. Epub 2020 Nov 18.
The treatment of suicidal patients often suffers owing to a lack of integrated care and standardized approaches for identifying and reducing risk. The National Strategy for Suicide Prevention endorsed the Zero Suicide (ZS) model, a multi-component, system-wide approach to identify, engage, and treat suicidal patients. The ZS model is a framework for suicide prevention in healthcare systems with the aspirational goal of eliminating suicide in healthcare. While the approach is widely endorsed, it has yet to be evaluated in a systematic manner. This trial evaluates two ZS implementation strategies statewide in specialty mental health clinics.
METHODS/STUDY DESIGN: This trial is the first large-scale implementation of the ZS model in mental health clinics using the Assess, Intervene, and Monitor for Suicide Prevention (A-I-M) clinical model. Using a hybrid effectiveness-implementation type 1 design, we are testing the effectiveness of ZS implementation in 186 mental health clinics in 95 agencies in New York State. Agencies are randomly assigned to either: "Basic Implementation" (BI; a large group didactic learning collaboratives) or "Enhanced Implementation" (EI; participatory small group learning collaboratives; enhanced consultation for site champions). Primary outcomes include suicidal behaviors, hospitalizations and Emergency Department visits; implementation outcomes include protocol adoption, protocol fidelity and barriers/facilitators to implementation.
This project has the potential to have a significant public health impact by determining the effectiveness of the ZS model in mental health clinics, a setting where suicide attempts and suicides occur at a higher rate than any other healthcare setting. It will also provide guidance on the implementation level required to achieve uptake and sustainability of ZS.
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由于缺乏综合护理和标准化方法来识别和降低风险，自杀患者的治疗往往受到影响。《国家预防自杀战略》支持“零自杀（ZS）”模式，这是一种多组件、全系统的方法，用于识别、参与和治疗自杀患者。ZS 模式是医疗保健系统预防自杀的框架，其理想目标是消除医疗保健中的自杀。虽然这种方法得到了广泛的认可，但它尚未得到系统的评估。本试验在全州的专业心理健康诊所评估两种 ZS 实施策略。
方法/研究设计：本试验是首次在心理健康诊所使用评估、干预和监测预防自杀（A-I-M）临床模型大规模实施 ZS 模型。采用混合有效性-实施类型 1 设计，我们正在测试 ZS 在纽约州 95 个机构的 186 家心理健康诊所中的实施效果。机构被随机分配到以下两种方案之一：“基本实施（BI；大型小组讲座式学习合作）”或“强化实施（EI；参与式小组学习合作；为现场负责人提供强化咨询）”。主要结局包括自杀行为、住院和急诊就诊；实施结局包括方案采用、方案忠实度以及实施的障碍/促进因素。
本项目有可能通过确定 ZS 模型在心理健康诊所中的有效性产生重大的公共卫生影响，因为自杀企图和自杀发生的频率比任何其他医疗保健环境都高。它还将为实现 ZS 的采用和可持续性所需的实施水平提供指导。
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